BMJ Case Reportshttp://casereports.bmj.com
http://casereports.bmj.com/cgi/content/short/2014/mar20_1/bcr2013202371?rss=1
A 48-year-old male patient presented to the emergency room with a history of chest pain and breathlessness. Chest X-ray demonstrated a large radio-opaque foreign body in relation to the proximal right bronchial tree. The patient subsequently revealed a history of a misplaced denture 4 months previously. Urgent flexible bronchoscopy (FB) examination demonstrated a large partial denture impacted in the right intermediate bronchus, which was removed successfully using a flexible bronchoscope. Although rigid bronchoscopy (RB) is the procedure of choice for large-sized and impacted airway foreign bodies, the present case highlights the utility of FB in airway foreign body removal. In clinically stable patients with foreign body inhalation, FB can be employed initially as it is an outpatient and cost-effective procedure which can obviate the need for administration of general anaesthesia.Jamshed, N.Madan, K.Ekka, M.Guleria, R.2014-03-20doi:10.1136/bcr-2013-202371Successful flexible bronchoscopic management of a large-sized aspirated partial dentureBMJ Publishing Group LtdMAR20_120142013202372014-03-20CASE-REPORThttp://casereports.bmj.com/cgi/content/short/2014/mar19_1/bcr2014203676?rss=1
A 35-year-old woman, a non-smoker with a normal body mass index, felt wheezy' and developed profound hypoxia 30 min after preterm vaginal delivery at 24+ weeks of gestation. She denied other symptoms, had no fever but was tachycardic and tachypnoeic with normal blood pressure. Pulmonary embolism, amniotic fluid embolism, cardiomyopathy, arrhythmias, sepsis and non-cardiogenic pulmonary oedema were considered as differential diagnoses. Chest X-ray showed an increased pulmonary vasculature, but the blood tests, ECG, echocardiogram and CT pulmonary angiogram were essentially normal. She was managed on a high dependency area with high-flow oxygen and intravenous antibiotics. She improved dramatically and the oxygen requirements dropped to 2 L over the next 4 h. It is plausible that this woman had acute non-cardiogenic pulmonary oedema secondary to a combination of risk factors. This case highlights the importance of a methodical and multidisciplinary approach for a prompt diagnosis and successful treatment of an acutely ill parturient.Bhandari, H. M.Gorecha, M.Woodman, J.2014-03-19doi:10.1136/bcr-2014-203676Acute respiratory failure in a 35-year-old woman following preterm vaginal deliveryBMJ Publishing Group LtdMAR19_120142014203672014-03-19CASE-REPORThttp://casereports.bmj.com/cgi/content/short/2014/mar18_1/bcr2013201127?rss=1
Description A 61-year-old man with light chain multiple myeloma underwent autologous bone marrow transplantation (BMT). One week later, a lower respiratory tract infection developed with neutropenic sepsis and multiorgan failure necessitating intensive care unit admission. Progressive and persistent bilateral infiltrates on chest radiography indicated acute respiratory distress syndrome and requirement for high-frequency oscillatory ventilation (HFOV) following a trial of conventional mechanical ventilation. Chest radiography showed bilateral subcutaneous emphysema but no evidence of pneumothorax (figure 1). This rapidly progressed to involve his face, torso, arms and lower limbs. CT showed pneumomediastinum with significant bilateral subcutaneous emphysema but without pneumothorax (figure 2). With no pleural air collection, the risks of chest drain insertion outweighed its benefits and decomp ...Chotirmall, S. H.Morgan, R. K.2014-03-18doi:10.1136/bcr-2013-201127Subcutaneous emphysemaBMJ Publishing Group LtdMAR18_120142013201122014-03-18CASE-REPORThttp://casereports.bmj.com/cgi/content/short/2014/mar13_1/bcr2014203861?rss=1
A 61-year-old man complained of cough and dyspnoea after exposure to colophony-containing solder fumes at work. A histamine challenge test confirmed airway hyper-responsiveness, and colophony-challenge demonstrated a 16.7% drop in peak expiratory flow rate (PEFR), supporting a diagnosis of colophony-induced occupational asthma. At review, the patient presented with cough, dyspnoea and wheeze that occurred acutely when exposed to the fumes from burning incense during Easter Saturday services, necessitating his departure from the church. Inhalation challenge tests using two blends of incense used at his church (Greek and Vatican) led to identical symptoms and a significant reduction in forced expiratory volume in 1 s 15 min after exposure and PEFRs up to 48 h after exposure, indicating an early and late phase asthmatic reaction. This is the first report of coexistent colophony and incense-induced asthma. The similarities in chemical structures between abietic acid in colophony and boswellic acid in incense suggest a common mechanism.O'Connor, T. M.Cusack, R.Landers, S.Bredin, C. P.2014-03-13doi:10.1136/bcr-2014-203861Holy Saturday asthmaBMJ Publishing Group LtdMAR13_120142014203862014-03-13CASE-REPORThttp://casereports.bmj.com/cgi/content/short/2014/mar12_1/bcr2013202864?rss=1
We describe a case where full-thickness excision of a rectal lesion caused massive surgical emphysema and subsequent hypercarbia with associated difficulties with ventilation. This unique case highlights the risks of respiratory failure with extraperitoneal insufflation as in this case and as more commonly with intraperitoneal insufflation. Transanal endoscopic microsurgery (TEMS) is a technique that is being increasingly used in the management of large and early malignant rectal polyps. We reviewed the literature in order to understand the case and to highlight factors that should minimise any adverse sequelae. In the presence of ventilatory difficulties secondary to postoperative surgical emphysema, whether via extraperitoneal insufflation as described here or with intraperitoneal insufflation (as in laparoscopy), consider decreasing gas pressures, expediting the procedure, delaying extubation and prolonged close monitoring in recovery with possible admission to a high dependency unit (HDU) or intensive care unit (ICU).Chandra, A.Clarke, R.Shawkat, H.2014-03-12doi:10.1136/bcr-2013-202864Intraoperative hypercarbia and massive surgical emphysema secondary to transanal endoscopic microsurgery (TEMS)BMJ Publishing Group LtdMAR12_120142013202862014-03-12CASE-REPORThttp://casereports.bmj.com/cgi/content/short/2014/mar12_1/bcr2013201320?rss=1
The diagnosis of pulmonary embolism (PE) can be difficult to make. The consequences of missing a PE can be fatal and clinicians should always be vigilant. This case presents a patient admitted with fluctuations in consciousness and in a septic state. A preliminary diagnosis of aspiration pneumonia was made, and the patient went on to have an exploratory surgical procedure with no remarkable findings. Only after further investigation of the patient's fluctuations in consciousness was a retrospective diagnosis of a large PE made. The patient was anticoagulated and made a full recovery, with no outstanding pulmonary issues at follow-up 6 weeks after discharge. A prolonged immobile state, likely in part due to the patient's septic state and psychiatric history, along with recent surgery and hospitalisation were the most obvious risk factors.Lee, N.Bax, S. R.2014-03-12doi:10.1136/bcr-2013-201320Muddy clinical waters: a missed pulmonary embolusBMJ Publishing Group LtdMAR12_120142013201322014-03-12CASE-REPORThttp://casereports.bmj.com/cgi/content/short/2014/mar11_2/bcr2013202560?rss=1
Broncho-oesophageal fistula (BEF) of benign aetiology is rare. BEF is a rare complication of intrathoracic involvement with tuberculosis. A high index of suspicion and appropriate investigations can lead to achieving an early diagnosis following which appropriate management can be timely instituted. Surgery can be avoided if the condition is recognised in early stages. We present a case of a young female patient with tubercular mediastinal lymphadenopathy complicated by left broncho-oesophageal fistulisation. Timely initiation of conservative medical management was followed by an uneventful recovery.Madan, K.Venkatnarayan, K.Shalimar, Mohan, A.2014-03-11doi:10.1136/bcr-2013-202560Successful medical management of tuberculous broncho-oesophageal fistulaBMJ Publishing Group LtdMAR11_220142013202562014-03-11CASE-REPORThttp://casereports.bmj.com/cgi/content/short/2014/mar11_1/bcr2013200950?rss=1
A 42-year-old man with a significant smoking history presented with chronic expectorative cough and exertional shortness of breath with recent-onset hoarseness. Chest examination was essentially normal and cardiovascular examination was suggestive of aortic regurgitation. Ears, nose and throat evaluation showed left vocal cord palsy and CT scan revealed an aortic arch aneurysm. Ortner's syndrome refers to hoarseness due to recurrent laryngeal nerve palsy secondary to a cardiovascular abnormality. Aortic aneurysms usually present with chest pain, back pain or epigastric pain, depending on the site of the aneurysm. An aortic arch aneurysm presenting as hoarseness is extremely rare.Shahul, H. A.Manu, M. K.Mohapatra, A. K.Magazine, R.2014-03-11doi:10.1136/bcr-2013-200950Ortner's syndromeBMJ Publishing Group LtdMAR11_120142013200952014-03-11CASE-REPORThttp://casereports.bmj.com/cgi/content/short/2014/mar10_1/bcr2013202365?rss=1
Our patient presented with repetitive, self-limited bouts of forceful hiccups in sleep. Eszopiclone, a commonly prescribed hypnotic, appeared to cause these intermittent hiccups. This case is a reminder that eszopiclone may cause this adverse effect, and that it may be the bed partner and not the patient who furnishes critical sleep medicine history.Vorona, R. D.Szklo-Coxe, M.Ware, J. C.2014-03-10doi:10.1136/bcr-2013-202365Hypnotic hiccupsBMJ Publishing Group LtdMAR10_120142013202362014-03-10CASE-REPORThttp://casereports.bmj.com/cgi/content/short/2014/mar07_1/bcr2013203276?rss=1
Description An initial CT scan of the chest of a 73-year-old man showed an incidental 22-mm-wide cavitating lesion with a central small mass in the left upper lobe of his lung. He had a history of persistent cough with minimal expectoration for many years and was breathless on exertion. He never had haemoptysis. He had a history of tuberculosis (TB) from his childhood and had asthma. He had minimal change nephropathy diagnosed in 2000, of which he had several relapses over the past 9 years, responding to steroids. On examination, he was found normal. Bronchial brushings showed fungal elements and blood tests confirmed Aspergillus.
He developed a left-sided chest discomfort and increased cough and sputum production whenever he lied on his back or left side, but with no haemoptysis. On review of the CT scan, it was demonstrated that the cavity containing the aspergilloma was connected to the left main bronchus, which would explain these sli ...Singh, H.2014-03-07doi:10.1136/bcr-2013-203276Aspergilloma in a patient with a history of TBBMJ Publishing Group LtdMAR07_120142013203272014-03-07CASE-REPORT